![]() ![]() Of note, no atrial loop was created this time in order to potentially avoid loop migration ( Figure 1A). The lead was tested for adequate sensing and pacing threshold. The left subclavian vein was punctured and a 59 cm SelectSecure 3830 lead was delivered to his right ventricular outflow tract (RVOT) septum using an 8.4 Fr deflectable sheath. The implantation procedure was performed under general anaesthesia. ![]() He had a mild degree of lethargy but was otherwise well and his physical examination was normal with no evidence of heart failure. He underwent an implantation of transvenous VVIR pacemaker in 2004 when he was aged 3 years and 8 months as he became progressively bradycardic with resting ventricular rate below 45 b.p.m. He was otherwise healthy with no comorbidities. with evidence of CHB on his electrocardiogram (ECG). During that admission, he was noted to be persistently bradycardic ranging from 60 to 80 b.p.m. We report two cases of late lead dislodgement of 4.1 Fr SelectSecure 3830 in two patients with congenital complete heart block (CHB).Ī 15-year-old boy was diagnosed with congenital CHB at 9 months of age when he was admitted with a suspected but unconfirmed diphtheria throat infection. Several studies have reported complications related to other brands of leads dislodging in paediatric patients during early 3–5 and medium-term 1 follow-up. One of the potential long-term pitfalls of this very sturdy pacing lead is retraction and lead dislodgement with linear growth in children. The lead is easily delivered using the 8.4 Fr deflectable delivery catheter (SelectSite C304, Medtronic Inc., Minneapolis, MN, USA) or can be delivered through pre-shaped guiding catheters or even peel-apart introducer sheaths in small children and infants. The lead has active fixation with a steroid eluting non-retractable screw-in tip. The use of composite insultation materials allows this thin lead to have high crush resistance. The conductors are separated by a layered insulation of ethylene–tetrafluoro–ethylene. It is lumenless with a cable cathode conductor and an anode conductor that is externally wound around in helical fashion. This 4.1 French (Fr) bipolar lead is the thinnest lead available since 2000. The SelectSecure 3830 lead (Medtronic Inc., Minneapolis, MN, USA) is often the pacing lead of choice for transvenous pacing in children because of its small diameter and reliable long-term sensing and pacing abilities, therefore, avoiding frequent lead revisions. 1, 2 However, the life-long pacing requirement in linearly growing paediatric patients presents ongoing unique challenges to lead selection and placement. With the advances in pacemaker generator and lead designs over the past three decades, there has been a gradual shift towards placement of transvenous pacing systems in young children with encouraging short and medium to long-term outcomes. ![]()
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